Seòmar agus comataidhean

I have a focus on governance and implementation. I answered the same question from Mr O’Kane. As well as the practical support provided through MIST to get the 10 standards embedded by next April, its work covers at least a three-year period for quality improvement and quality assurance. I said to Mr O’Kane that the last thing we want to do is to put all that additional investment, time, resource and support to embed the standards and then sit back and relax. We cannot sit back and relax; we need to keep on this.

We know from that information that 13 per cent of beds that were accessed in that timeframe came from alcohol and drug partnership funding, and that there were also publicly funded places from housing benefit and social security. People would be accessing private and charitable funding as well.

Regarding the first quarter of this calendar year, you might recall that we published information on how the emergency funding was used. In the period from January to March, we quickly initiated £5 million out the door, and £3 million of that went to ADPs. Some of that money was for a separate improvement fund that people could apply for. There was also a grass-roots fund. We published information on how ADPs allocated that money, so that is available. We are currently gathering further information from ADPs and, again, we will make that available.

As for what we know about current capacity, earlier this year we published information on how, overall, the 20 facilities in Scotland were operating at about two-thirds capacity, so we know that there is capacity there to be utilised. I have given a commitment to return to Parliament with our milestones over the next five years. That is about how to improve access—and, as Ms Wells rightly points out, it is also about the extent to which we will improve capacity over the next five years. We will come to Parliament with much more detail on that.

Social isolation is also a public health issue. Committee members might be aware that a few years back the Government introduced a tackling isolation and loneliness strategy, and there is a range of investments and funds around that.

With regard to tackling drug-related deaths, I have to point to the lived experience and recovery community, because much of what they do is based on their own, real-life experience and the expertise that they bring to the community.

Mobilising the lived-experience community can help to reach people that services might struggle to reach. The relationship aspect of support is crucially important. The peer navigator system that Medics Against Violence have been strong proponents of in our prisons and hospitals is also really important. Peer navigators with lived experience from organisations such as Aid & Abet make contact with people when they come into police custody. All of that is about making connections and building relationships with people to support and help them in their onward journey, and it goes along with referring them to services.

That is a really important question, Mr Gulhane; I know that you are a former GP. I often talk about our life-saving work being connected to the work to improve people’s lives. You and I may take the role of primary care for granted in our own lives, but I know that many general practices are the front line of our communities and are already doing great work to support people and their families who are struggling with drug use.

We are finding across Scotland that there are different pictures of the organisation of services. In some areas, GPs can offer more services to people who are affected by drug use, while in others pathways and routes point more towards specialist services. Regional variation is fine as long as it works.

However, in taking a public health approach, GPs can play an absolutely core role. Part of my job is to engage with clinicians from all backgrounds—psychiatrists, GPs and clinicians from specialist addiction services. The connection between the important issue of harm reduction and immediate access to treatment for a drug problem and primary care is made in standard 7 of the new medication-assisted treatment standards. People should have choice with regard to the connections between their MAT and primary care.

There are two important strands to that question, but the committee will appreciate that my work on reducing drug-related deaths focuses primarily, although not exclusively, on illicit drug use. My colleagues in public health focus more on how we reduce dependency on prescribed drugs.

The issue is of interest to me, however, because we know—I am not telling you anything that you do not know—that people can, and do, become addicted to prescribed drugs. A consultation took place on the recommendations of the short-life working group, and health colleagues are implementing an action plan about prescribing guidance and assessing, monitoring and recording prescriptions.

It is a side issue, but the Royal Pharmaceutical Society is interested in how it could work with Government to implement a tool that better records the amount of over-the-counter medications that people buy, because that is an issue for some people as well.

The prescribing guidance around proscribed drugs is complementary to the prescribing guidance around illicit benzodiazepine use. For the drugs policy division, the work to reduce dependency on and the use of illicit benzodiazepines in our communities is connected to the work around prescribed benzodiazepines, for example. We are involved in a range of work—in devolved and reserved areas—to tackle the issue around street Valium as well. I will stop here, convener. Someone might want to pick up the benzodiazepine issue later.

You are quite correct to be making all those connections. It is important that strategies and approaches complement and connect with one another. There is a lot to learn from other campaigns and approaches.

One example is the use of Buvidal, which was introduced into the prison estate during the pandemic. Buvidal is a long-acting buprenorphine that can be administered as an injection weekly or monthly; it does not require a daily dosage. The use of Buvidal in prisons was evaluated very positively. It will not suit everybody—it is important to stress that no treatment will meet the needs of everyone—but it had some benefits in terms of clarity of thought and of not tying people to daily dispensing. It is also rarely associated with overdose, because it is a protective factor in relation to how opioids attach to brain receptors. It is a bit like a blocker: if you take an opioid on top of your Buvidal, you do not get the high from the opioid.

Having looked at the results of Buvidal in some of our prison estate, I was keen to find out how we could introduce it to the community and widen access to treatment. That is why this financial year there is a £4 million investment in widening choice to people, and that includes Buvidal. Widening that choice of treatment is a change in practice that occurred in response to the pandemic, but it is one that we want to continue and to implement further.

The committee has already spoken about our work around naloxone as well and how its distribution has widened during the pandemic. We do not want to detract from that change.

We must stick with people. There is an important role for us in changing how our statutory, NHS and local government services work and how they meet the needs of people who struggle with drugs and the needs of their families.

The third sector has a valuable role. We have taken a belt and braces approach. As well as increasing the investment in ADPs, many of which will enter into agreements with the third sector, we have set up the four multiyear funds that are within the £18 million pot and are available to third sector organisations. The third sector is vital, along with our public services and the lived and living experience community. Those are the three strands of the partnership: the lived and living-experience community, the third sector and statutory services.

A lot would depend on the nature of the care that they are receiving. If we are talking specifically about medication-assisted treatment, that needs to be delivered by someone who is qualified to prescribe. The important thing about the medication-assisted treatment standards is that they make connections with other aspects of treatment—what is collectively known as psychosocial treatment and work to help people to address past trauma. A lot would depend on the type of care required and the type of care available in a local practice.

The funding arrangements for general practice sit with the Cabinet Secretary for Health and Social Care, and I assure you that he engages well and often with the GP community on the host of issues that flow from the GP contract. I have opportunities with the additional resource that we have to reduce drug-related deaths, but it is not prescriptive—I have not said that all that money goes to ADPs or the third sector. It is about investing in services and approaches where the evidence shows that lives can be saved.